Large-scale combat operations (LSCOs) may generate casualty surges that overwhelm the capabilities and capacities of the U.S. health care system. The National Institute for Defense Health Cooperation (NIDHC) leads a Congressionally directed effort to assess and make recommendations for strengthening the Nation’s combined military and civilian health systems through the National Disaster Medical System (NDMS) Pilot Program. To inform Pilot Program activities, NIDHC established the Council of Chief Medical Officers (CoCMOs), convening Chief Medical Officers (CMO) from civilian health systems strategically relevant to the Pilot. The goal of the Council is to improve national understanding of civilian hospital surge capacity, preparedness, and response, and identify potential courses of action that could enable civilian hospitals to more efficiently and effectively increase capacity during LSCO. We conducted a qualitative exploratory study using semi-structured facilitated discussions with Council members and their colleagues to examine surge capabilities within civilian hospitals and health systems that could support military casualties during a LSCO. This poster presentation will describe findings from this study, including (1) a description of the current state of surge preparedness within U.S. civilian health systems; (2) identification of operational, regulatory, and policy barriers to civilian medical surge response; and (3) recommendations for addressing these barriers and otherwise strengthening LSCO-driven surge response in civilian health systems.